Student One-time Attestation Form 8/25/2021
The Rhode Island Board of Education and the Rhode Island Department of Health requires each student and staff to self-certify that they are symptom free before coming to school.

Fully vaccinated individuals students and staff are not subject to close contact or travel quarantines. Vaccinated staff and students will have to schedule and provide COVID 19 test results if identified as a close contact on day 5-10 post exposure, but may continue to attend school.

The form below will serve as your attestation form for  the 2021-2022 school year. Staff and students should review the attestation daily.

**Please fill out one form per student.

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Location *
Grade Level *
Student Name (Last, First) *
I will not come to school if I experience any of the following symptoms listed(applies to both unvaccinated and fully vaccinated individuals): * Fever, (100.0 or higher) *Chills, *Cough (New), *Shortness of breath or difficulty breathing, *Fatigue, *Headache, *Sore throat, *New loss of taste or smell, *Congestion or runny nose (new), *Nausea or vomiting, *Diarrhea. *
I will not come to school if I have been in close contact with a confirmed case of COVID 19 or if I test positive, until I have been cleared by the school nurse. A close contact is defined as: being directly exposed to infectious secretions (e.g. being coughed on while not wearing a mask) or being within 6 feet for a cumulative duration of 15 minutes, (with or without a mask) with a person who tested positive for COVID 19. *
If I am not fully vacinated, I will not come to school if a symptomatic household member has been tested for COVID 19 until negative test results are received. If positive, I will contact the school nurse for the quarantine period. *
I will not come to school if I have traveled anywhere outside the 50 US states.  For vaccinated people a negative COVID PCR test is required on day 5 and a quarantine in not required.  Unvaccinated people will follow the quarantine protocols as well. *
I agree to follow the exposure and travel protocols per the RIDOH Playbook, as directed by the school nurse as appropriate. *
If I am unsure if I should come to school- I will contact the school nurse before entering my building. *
Please Sign Below: *
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